Dont open launcher options or it will reset the INI files and remove some tweaks.

Just a warning, the line ipresentinterval is default set to 1,
setting it to 0 disables Vsync and removes fps cap but causes bugs and problems,
so just set it back to 1 if you encounter problems.

Try setting fallout4.exe or launcher.exe compatibility mode to windows 7 people reported it helped with performance.
Also try setting fallout4.exe priority to high in task manager.
Confirmed to be working set it to windowed and borderless for less stuttering.

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